Risk of Ovarian Malignancy Algorithm (ROMA)

The Risk of Ovarian Malignancy Algorithm (ROMA), also known as the ROMA index or ROMA algorithm, stratifies women with a documented adnexal or pelvic mass into high- and low-risk groups for epithelial ovarian cancer by combining CA 125 and HE4 results with menopausal status. The risk estimate can inform referral to gynecologic oncology and assist in preoperative planning. ROMA is not intended for population screening and is not used to evaluate non-epithelial ovarian neoplasms.

ROMA is a probabilistic model that incorporates serum concentrations of CA 125 and HE4 together with menopausal status to estimate the likelihood of epithelial ovarian malignancy. CA 125, a circulating glycoprotein, is commonly elevated in advanced epithelial ovarian cancer but has limited sensitivity in early-stage disease. HE4, a secreted protease inhibitor overexpressed in epithelial ovarian cancer, provides additional discrimination beyond CA 125 alone. Across validation cohorts of women with adnexal masses, the ROMA index typically demonstrates high sensitivity with moderate specificity for identifying epithelial ovarian cancer and performs favorably relative to the Risk of Malignancy Index (RMI). The algorithm applies only to epithelial ovarian tumors and does not assess risk for germ cell or sex cord–stromal neoplasms. ROMA is intended for risk stratification in patients with a confirmed pelvic or adnexal mass and should be interpreted alongside the clinical evaluation, imaging findings, and other laboratory data.